Kids' Grief for Dead Parent Can Stay Intense for Years

Action Points

Explain that a longitudinal study of children and adolescents who lost a parent to sudden death found that the majority had a steady improvement in grief symptoms over the course of the first year.

Point out that 31% still had severe grief reactions at nine months that had not faded, and 10% had intense reactions out to three years after the death, which influenced their own functionality in school and with peers.

Nine months after the sudden death of a parent, grief reactions of most children were relatively low, and they continued to fade with time, but for some 40% that was not the case, researchers found.

For 31% grief was still severe at nine months and in another 10% it remained intense nearly three years after the parent's death, according to Nadine Melhem, PhD, of the University of Pittsburgh, and colleagues.

In turn, prolonged grief appeared to be a significant predictor of new-onset, full-blown depression as well as functional impairment involving school performance, peer relations, and other activities important for children and adolescents, they reported in the September issue of Archives of General Psychiatry.

Persistent grief in the surviving parent was also associated with the risk for incident depression in the bereaved child, the researchers found.

"Adaptations of successful adult treatment approaches to the treatment of prolonged grief in children and adolescents may require interventions that are focused on the family rather than on the individual," Melhem and colleagues wrote.

They noted that death of a parent affects about 5% of American children and teens and is "one of the most stressful life events" for this age group.

The study focused on 182 children, 7 to 18 years old who had lost a parent without warning. They were interviewed at several points afterward, starting at a mean of 8.5 months (SD 3.7) after the parent's death. Subsequent interviews were conducted about one and two years later. Surviving parents were interviewed as well.

Grief reactions were assessed with a version of the Inventory of Complicated Grief adapted for children. Other psychometric instruments were used as well, evaluating depression, suicidality, post-traumatic stress, and other states.

Melhem and colleagues found that participants could be divided into three groups based on the pattern of their grief responses over time.

One group, which included 107 of the children and teens, had grief scores in the lower half at the first interview which then declined significantly by the second interview and remained low to the final evaluation.

The second group comprised 56 participants. They had initial grief scores at the 75th percentile, falling steadily through the third interview.

In the third group, with 19 participants, grief scores at nine months were also relatively high; the scores showed no significant decline at subsequent assessments.

Participant characteristics that were associated with classification into the latter two groups versus the first included accident as the parent's cause of death (as opposed to suicide or sudden illness) and higher self-reported depression at the nine-month interview.

Also, group three, relative to the other two groups, was marked by a higher prevalence of previous depression, new-onset PTSD, and functional impairment at nine months.

Incident depression was also more common in groups two and three -- affecting half of participants in both groups by the third interview, compared with about 25% in group one (P<0.05).

In all three groups, most of those who developed depression did so within the first month of the parent's death.

"Future studies are needed to examine the long-term mental health and developmental outcomes in bereaved children and adolescents," Melhem and colleagues concluded.

Such studies should also seek "to examine the etiologic and biological pathways by which prolonged grief exerts its effects, and to develop interventions to promote relief from grief" in children and adolescents after the death of a parent, they added.

The researchers cautioned that the study had several limitations, including the fact that the recruitment methods, which included newspaper ads, could have led to a nonrepresentative sample.

Children of parents killed in homicides or whose deaths were anticipated were excluded, and the study population was mostly white, potentially limiting generalizability.

The study was supported by the National Institute of Mental Health and the American Foundation for Suicide Prevention.

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